Imaging of heart disease in women: review and case presentation

Abstract

Cardiovascular diseases (CVD) remain the leading cause of mortality worldwide. Although major diagnostic and therapeutic advances have significantly improved the prognosis of patients with CVD in the past decades, these advances have less benefited women than age-matched men. Noninvasive cardiac imaging plays a key role in the diagnosis of CVD. Despite shared imaging features and strategies between both sexes, there are critical sex disparities that warrant careful consideration, related to the selection of the most suited imaging techniques, to technical limitations, and to specific diseases that are overrepresented in the female population. Taking these sex disparities into consideration holds promise to improve management and alleviate the burden of CVD in women. In this review, we summarize the specific features of cardiac imaging in four of the most common presentations of CVD in the female population including coronary artery disease, heart failure, pregnancy complications, and heart disease in oncology, thereby highlighting contemporary strengths and limitations. We further propose diagnostic algorithms tailored to women that might help in selecting the most appropriate imaging modality.

Machine Learning and Bias in Medical Imaging: Opportunities and Challenges

“…38,39 These facilitated assessments are especially relevant for closing diagnostic care gaps between men and women-who tend to have smaller caliber coronaries and relatively less cardiac mass-and whose heart disease is more likely to involve inflammation, microvascular disease, and dysfunction, and heart failure with preserved ejection fraction (Figure 3; Sections 1.2.1.1 and 1.2.1.2). 40 Importantly, recent studies have shown not only that ML models reduce variability while also being concordant with human-made measurements, but that the algorithms can leverage information even from poor-quality images and perform consistently in men and women. 38,39,41,42 In fact, recent randomized trial data by our group have demonstrated noninferiority and even superiority of deep learning algorithms compared with conventional human-driven workflows for reproducibly measuring ejection fraction from clinical echocardiograms.…”

L’Équilibre Périlleux: Mental Stress and Inflammation in Women

“…19 In their significant contribution, Dai et al also highlight the critical role that multimodality cardiovascular imaging can play in identifying sex-specific biomarkers associated with amygdala activity and cardiovascular outcomes. 20 Although the expression mental stress relates to an array of experiences, amygdala imaging with 18 F-FDG-PET allows quantifying its neural substrate in an objective manner. Noninvasive imaging also helps visualize the underlying mechanisms connecting the brain and coronary arteries and unveil sex differences in the neuro-cardiovascular connectors.…”

Approach to Imaging Ischemia in Women

“…Newer imaging modalities are substantially more specific and sensitive for the detection of ischemia and CAD and less prone to sex-specific performance variation. Patient-centered approach based on specific clinical presentation, risk stratification, and safety considerations, such as breast radiation and pregnancy, should be used to select the optimal diagnostic approach 77 . The end goal is prompt and accurate diagnosis of women with ischemic heart disease with or without obstructive coronary artery disease to ensure prompt start of aggressive guideline-directed therapy (Table 1).…”